An estimated 38% of patients who receive an implantable cardioverter defibrillator (ICD) experience symptoms that meet diagnostic criteria for an anxiety disorder (Sola &Bostwick, 2005). Activation of ICDs signals a potentially life-threatening arrhythmia, and patients typically experience ICD shocks as unpredictable, frightening, and painful. Several theories of anxiety and associated empirical support suggest that fear of anxiety (i.e., anxiety sensitivity;AS), fear of being shocked (i.e., shock anxiety;SA) and fear of pain (FP) as well as avoidant behavior (i.e., attempts to regulate the fear of a negative event by avoiding it) are important in the development and maintenance of anxiety symptoms and diagnoses (Barlow, 2004). The predictive utility of AS, SA, and FP and potential avoidant mechanisms in patients who adjust poorly following ICD implantation are not firmly established. The study proposed herein will be one of the first longitudinal cohort studies to evaluate these fear constructs as predictors of anxiety severity following ICD implantation and to probe avoidant behavior as a mechanism by which these factors may increase post-implant anxiety. Seventy patients scheduled for ICD implantation who have no history of Axis I diagnoses will complete assessments of AS, SA, FP, avoidant behavior, and anxiety severity at baseline and at 2 weeks and 4 weeks post-implant. It is hypothesized that AS, SA, and FP will predict increased anxiety severity following ICD implantation, and that avoidant behavior will mediate this relationship. The proposed research fits with the NIMH clinical research vision by aiming to increase the capacity to predict the risk for anxiety disorders among patients receiving ICDs, with participation from a diversity of people in a specialty health care setting. If our hypotheses are supported, future work will involve pre-empting the disease process, possibly with interoceptive exposure prior to ICD implantation, and personalizing cognitive-behavioral interventions by addressing risk and mediating factors. The proposed research also targets an objective described in the FOA for Research on Co-Morbid Mental and Other Physical Disorders (PA-08-029), which is to clarify "the mechanisms that link co-morbid mental and other physical disorders, particularly the mechanisms that have a relatively large influence on the development of these co-morbid disorders and can also be modified through intervention." In short, the novel findings that are anticipated may help to identify ICD patients at high risk for anxiety disorders. Findings may also begin to lay the groundwork for developing tailored interventions to prevent the onset of post-implant anxiety. PUBLIC HEALTH RELEVANCE: The proposed research fits with the NIMH clinical research vision by aiming to increase the capacity to predict the risk for anxiety disorders among patients receiving ICDs, with participation from a diversity of people in a specialty health care setting. The novel findings that are anticipated may begin to lay the groundwork for developing tailored interventions to prevent the onset of post-implant anxiety.